| NPI | 1497113849 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | 
| Additional Taxonomies | 246ZE0500X Specialist/Technologist, Other, EEG | 
| Enumeration Date | 2016-01-31 | 
| Last Update Date | 2016-01-31 |